Elder J P, Louis T, Sutisnaputra O, Sulaeiman N S, Ware L, Shaw W, de Moor C, Graeff J
School of Public Health, San Diego State University, CA 92181.
J Trop Med Hyg. 1992 Oct;95(5):301-8.
The Indonesian Ministry of Health relies on a network of over a million kader (community health volunteers) to bring primary health care to the village level. In West Java, the Department of Health's Control of Diarrhoeal Disease (CDD) Program recently carried out an extensive research and development effort to produce effective job aids for the kader in CDD and a training programme to teach their use. A set of counselling cards was produced to provide kader with a tool to diagnose and treat diarrhoea and teach the proper use of ORS. Researchers conducted a controlled evaluation in which they measured the cards' effectiveness through observations of kader performance and interviews with mothers they had counselled. In the intervention group, 15 kader underwent two days training in the use of the cards when diagnosing and advising treatment for cases of diarrhoea in their villages. The 16 control kader received comparable CDD training without the cards. Each group provided lists of local mothers they pledged to counsel during the coming weeks. Follow-up interviews were held with these mothers to test their level of knowledge on CDD and to observe their ability to mix ORS properly. Significant performance differences between the intervention kader and mothers, and the control kader and mothers, were demonstrated. The intervention kader were consistently more accurate in their diagnoses and recommendations for treatment with a mean of 83% accuracy vs 68% for the control kader. Mothers counselled by the intervention kader also prepared ORS significantly better than the mothers counselled by the control kader, with 97 vs 74% accuracy.
印度尼西亚卫生部依靠由一百多万名卡德（社区卫生志愿者）组成的网络，将初级卫生保健服务延伸至村级层面。在西爪哇省，卫生部的腹泻病控制（CDD）项目近期开展了广泛的研发工作，旨在为从事腹泻病控制工作的卡德制作有效的工作辅助工具，并制定一项培训计划以教授如何使用这些工具。制作了一套咨询卡片，为卡德提供诊断和治疗腹泻的工具，并教授口服补液盐（ORS）的正确使用方法。研究人员进行了一项对照评估，通过观察卡德的工作表现以及与他们提供咨询的母亲进行访谈，来衡量这些卡片的有效性。在干预组中，15名卡德接受了为期两天的关于在其村庄诊断腹泻病例并提供治疗建议时使用这些卡片的培训。16名对照卡德接受了类似的腹泻病控制培训，但没有使用这些卡片。每个小组都提供了他们承诺在接下来几周为其提供咨询的当地母亲名单。对这些母亲进行了后续访谈，以测试她们对腹泻病控制的知识水平，并观察她们正确配制口服补液盐的能力。干预组的卡德与母亲以及对照组的卡德与母亲之间在表现上存在显著差异。干预组的卡德在诊断和治疗建议方面始终更为准确，平均准确率为83%，而对照组卡德为68%。接受干预组卡德咨询的母亲在配制口服补液盐方面也明显优于接受对照组卡德咨询的母亲，准确率分别为97%和74%。
